What is rheumatoid arthritis?
Rheumatoid arthritis (RA) is an autoimmune disease which can affect people of any age. It causes hot, painful, stiff and swollen joints, typically starting in the small joints of the hands or feet. The normal role of your body’s immune system is to fight off infections to keep you healthy. In an autoimmune disease, your immune system starts attacking your own healthy tissues.
In RA, the immune system targets the lining of the joints, causing inflammation and joint damage. RA usually affects smaller joints, such as the joints in the hands and feet. However larger joints such as the hips and knees can also be affected. Rheumatoid arthritis affects nearly half a million Australians.
At present, the causes of rheumatoid arthritis are not fully understood and research continues. Rheumatoid arthritis can also be triggered by other factors, including smoking and a range of infections and viruses. Whatever starts the process, the main problem in rheumatoid arthritis is that your body’s immune system begins to target your joints. While the immune system usually protects you against infections, in rheumatoid arthritis it mistakenly treats the tissue of your joints as ‘foreign’.
The resulting inflammation can lead to the painful symptoms of arthritis and permanent damage to your bones and joints if untreated. Damage to your joints can be reduced with early and ongoing treatment.
Symptoms of RA
The symptoms of RA vary from person to person, however the most common symptoms may include:
- Joint pain, swelling, and tenderness to touch.
- Stiffness in the joints, especially in the morning.
- Joints being affected symmetrically (i.e. the same joints on both sides of the body).
How will my doctor diagnose rheumatoid arthritis?
There is no single test for rheumatoid arthritis. Because early diagnosis and correct treatment can reduce the impact of the disease, most people with symptoms of rheumatoid arthritis should visit a specialist doctor (a rheumatologist) as soon as possible. Specialists look at the results from a range of tests to help them decide whether a person has rheumatoid arthritis.
Your rheumatologist will:
- Talk to you about your symptoms, including where and when you feel joint pain.
- Check whether you have had fevers, lost weight or been very tired.
- Examine your hands, feet and other joints for swelling, heat, tenderness or bumps, called ‘nodules’.
- Take a blood sample to check whether your body’s immune system is activated and whether it is attacking your joints.
- Possibly use a needle to take a small amount of fluid from one of your affected joints.
- Send you to a radiologist for an x-ray or other scan, such as an MRI or ultrasound, of the affected joints.
For more information on RA, download the RA booklet from Arthritis Australia, which serves as a practical guide to treatments, services and lifestyle choices.
For more information and/or a guide for young adults, download the Living with arthritis, A guide for young adults booklet from Arthritis Australia website.
Living with arthritis
Living with rheumatoid arthritis can be challenging at times and it does affect different people in different ways. In some cases, the disease may disappear, or may come and go (‘flare’) for many years. For other people, the symptoms and disability may slowly worsen over time.
If left untreated, rheumatoid arthritis may lead to damage to joints that cannot be repaired. Other parts of the body may also be affected, such as your lungs or your eyes. Fortunately, these problems outside of your joints are uncommon and the risk is reduced dramatically with treatment.
Joint inflammation may initially cause ongoing pain and some degree of disability, which can affect your ability to work or undertake home duties. This may mean changing your role at work or asking for more support at home until treatment has become effective. However, more than half of the people who develop rheumatoid arthritis continue to work for 20 years after their diagnosis. The disease cannot be ‘cured’ at present, but for most people it can be controlled with ongoing care. Many people achieve remission, which is the goal of treatment — control of symptoms and return to normal function.
To help you in your arthritis journey, there are many useful tools and resources that can assist you, with some key guiding principles;
- Take control by knowing your disease.
- Don’t delay, see your doctor.
- Work with your healthcare team and be an important part of it.
- Know about your treatment options.
- Find new ways to stay active.
- Learn techniques to help manage your pain.
- Acknowledge your feelings and seek support.
- Make food choices that count.
- Balance your life.
- Call your local State or Territory Arthritis Office.
For further information on living well with rheumatoid arthritis, click here to view the Rheumatoid Arthritis booklet.
Will medicine cure my rheumatoid arthritis?
At present, there is no ‘cure’ for rheumatoid arthritis. However, early use of the right medicines, as discussed by our speakers, can slow down the damage caused by the disease, relieve pain and stiffness and reduce long-term disability. The aim of treatment is to achieve remission and return to your normal activities and for many people this is achievable.
What is the right medicine for me?
All medicines have risks and benefits, so before you start treatment talk to you doctor and pharmacist about how each medicine should be helping you and what risks it might have. Make sure your doctor knows about any other health problems that you or your family members have, as this can help them choose the best medicine for you, and be sure to act early, as early use of the right medicines can slow down the damage caused by the disease, relieve pain and stiffness, and reduce long-term disability.
You should also make sure that you understand what side effects the medicine might have, including what to do or whom to speak to if you experience any unwanted effects from your medication.
Many arthritis medicines need to be taken regularly to work properly and should not be stopped suddenly — talk to your doctor if you have concerns about side effects, safety or cost. As you may have heard in our speaker interviews, each person responds differently to arthritis medicines, which means that you will need to work with your specialist and GP to find the best medications and doses for you. This can take time, but by finding the most effective medicines with the least side effects, you can hope to really make a difference in controlling your rheumatoid arthritis.
Your disease may also change over time, including which joints are affected, how much pain or disability you experience and whether you have symptom-free periods. This means that you may need to change or add medicines over the course of your treatment — you may not be on the same medicine forever.
Some medicines can only be used once other medicines are no longer effective in controlling your arthritis, do speak to your doctor about any concerns you may have.
The following medicines may be used at various points in your journey;
- Painkillers such as paracetamol are often very helpful. They can be taken regularly and are particularly useful just before activity to keep your pain to a minimum. It’s best not to wait until you’re in severe pain before taking them. They don’t need to be taken with a meal, though some water and a small snack are advised.
- There’s a wide range of non-steroidal anti-inflammatory drugs (NSAIDs) that can reduce pain so you can get on with your daily activities and your exercise routine. You’ll probably need to take these during bad patches, and some people may need them over a longer period. Some tablets are made in a slow-release formulation, which can help with night-time pain and morning stiffness. Some NSAIDs are also available as gels, which you can apply to the painful area. Like all drugs, NSAIDs can sometimes have side-effects, but your doctor will take precautions to reduce the risk of these, for example by prescribing the lowest possible dose for the shortest possible period of time.
- Steroids can be used as a short-term treatment for flare-ups. They’re usually given as an injection into a swollen joint or as a slow-release injection into a muscle. They can also be used for painful tendons, for example at the heel, although they won’t be repeated very often as this may lead to tendon weakness. Occasionally, you may be given a course of steroid tablets. While these treatments can be very effective at improving pain and stiffness, you may develop side-effects if you use them for long periods, for example, weight gain, bruising or thinning of the skin, high blood pressure, high blood sugar or osteoporosis. If you develop eye inflammation, it will usually be treated with steroid eye drops. In more severe cases, steroids may be given as tablets or as an injection into the eye.
- Disease-modifying anti-inflammatory drugs (DMARDs) are designed to reduce damage to the joints rather than just ease your symptoms. They’re slow-acting so you won’t notice an immediate impact, but they’re very effective over a period of time. Drugs such as these can be helpful for arthritis in the joints of your arms and legs, although they’re not usually effective for spinal symptoms. When taking DMARDs, you’ll need regular check-ups and blood tests to monitor their effect. Methotrexate is one of the most commonly prescribed DMARD’s. This safe and effective drug has been used as first line therapy in RA (and other forms of inflammatory arthritis) for decades. Originally developed as a chemotherapy – methotrexate is used in RA in very small doses and works to ‘dampen down’ or modulate the overactive immune system, thereby reducing systemic inflammation. Taken on its own, or in conjunction with other DMARD’s, methotrexate has been shown to slow down the progression of the disease thus preventing or minimising damage to the joints, as well as reducing symptoms such as swelling, pain, morning stiffness and fatigue. Low dose methotrexate is a very effective treatment for many people with RA, and taken as directed, it can enhance mobility and function and improve quality of life.
- Biological therapies are relatively new treatments that can be very effective for rheumatoid arthritis. A number of drugs are currently available for rheumatoid arthritis. These biological therapies are currently only available to patients with more severe forms of the condition if it can’t be controlled with anti-inflammatory drugs and they may not be suitable for everyone. The effect of these drugs will be monitored, and you’ll need to complete questionnaires regularly which assess how active your disease is and how well it’s responding to treatment.
Exercise and activity information
Physical activity protects joints by strengthening the muscles around them. Strong muscles and tissues support those joints that have been weakened and damaged by arthritis. A properly designed program of physical activity reduces pain and fatigue, improves mobility and overall fitness, and alleviates depression. Physical activity allows someone with arthritis to have a more productive, enjoyable life. There are different types of exercises that you can do to lessen your pain and stiffness;
- Range of motion exercises reduce pain and stiffness and keep your joints moving. To achieve the most benefit, these exercises should be done daily.
- Strengthening exercises maintain or increase muscle tone and protect your joints.
- Moderate stretching exercises help to relieve the pain and keep the muscles and tendons around an affected joint flexible.
- Endurance exercises strengthen your heart, give you energy, control your weight and help you feel better overall. These exercises include things like walking, swimming and cycling. It is best to avoid high-impact exercises like step aerobics, jogging or kickboxing.
Inflammation in your muscles, tendons and other tissues may make it harder for you to stand up straight, turn and bend, or take a deep breath. Your physiotherapist or exercise physiologist can suggest suitable exercises to stretch and strengthen your muscles. These exercises will improve your posture and help to maintain flexibility. You should aim to do this stretching program every day, or at least five times per week. If you experience early morning stiffness, gentle stretching exercises under a warm shower will also help.
In addition to your stretching exercises, it is important to do at least 30 minutes of moderate exercise on most days of the week for your general fitness. You can do this either in one go or break your exercise into smaller efforts (for instance, three 10-minute or two 15-minute blocks per day).
Activities that are likely to be good for your fitness include walking, swimming, water exercise, low-impact aerobics and riding a bicycle or exercise bike. Your physio or exercise physiologist can also suggest specific exercises and stretches that are appropriate for your situation.
Ask your physio or exercise physiologist to create a special exercise program you can do at home or at the local gym or swimming pool.
Protecting your joints
You should always use your joints in ways that avoid excess stress. This allows you to experience less pain, perform tasks more easily and protect your joints from damage. Techniques to protect your joints include:
- Pacing by alternating heavy or repeated tasks with lighter tasks. Taking a break reduces the stress on painful joints and conserves energy by allowing weakened muscles to rest.
- Positioning joints wisely promotes proper alignment and decrease excess stress. For example, squatting and kneeling may put extra stress on your hips or knees. When lifting or carrying heavy items, keep items at waist height and avoid carrying them up and down stairs.
- Talk to your doctor about seeing an occupational therapist or physiotherapist, who may prescribe splints, braces or orthotics (shoe inserts) to help align and support your joints.
- Using assistive devices conserves energy and makes daily tasks easier. Raise seat levels to decrease stress on hip and knee joints. Use a reacher to pick up items from the ground. Use a cane to decrease stress on hip and knee joints. Enlarge grips on utensils, such as spoons or peelers, to decrease stress on delicate hand joints. Other devices to consider include carts for carrying objects and jar/tap openers.
For additional information on living at home with arthritis, review Arthritis Australia’s ‘At home with arthritis’ which outlines a range of simple steps for managing in the home.
Pregnancy and rheumatoid arthritis
If you are planning for a baby, discuss your plans with your doctor beforehand as some drugs can temporarily reduce fertility. Other drugs, such as methotrexate and leflunomide, can affect the baby’s development so it’s important to use reliable contraception while you’re taking these – this applies to men wanting to father a child as well as to women.
Most mothers with rheumatoid arthritis feel better during pregnancy, possibly because the activity of the immune system is reduced during pregnancy to ‘tolerate’ the growing baby. Symptoms are likely to return once the baby is born. However, any flare-up of symptoms after the birth can usually be dealt with quickly.
For women, the disease should not interfere with pregnancy, but you will need to discuss your medications with your doctor to minimise potential harm to your unborn baby. Some arthritis medicines can still be used during pregnancy if necessary, but many can harm the foetus and should not be taken while trying to conceive, when pregnant or during breastfeeding. For men, you should discuss your family’s pregnancy plans with your doctor so that they can review your medications if necessary.
‘Arthritis, Pregnancy and the Path to Parenthood’, published by Suzie May, details Suzie’s experience as a young Australian woman with rheumatoid arthritis, along with the experiences of other men and women from around the world as they fulfil their goal of becoming parents, despite their arthritis. This practical guide can help you understand the potential challenges you may face and give you strategies to overcome these challenges. The book is available here.
In addition, for women, Arthritis Australia has collated the personal stories of a range of women living with arthritis, known as ‘Women’s Insights into Rheumatoid Arthritis’.
What other assistance is available?
There are many resources available to help people with rheumatoid arthritis. Your doctor may put you in touch with a social worker, who can help explain the financial and health services that are available to you. These can include any pensions or allowances that you might be entitled to, plus any financial assistance such as Health Care Concession Cards or low-cost treatment programs. Your local council, community health centre, community group or religious organisation may also offer programs that include practical advice, activities, social networks or just someone to talk to. Arthritis Australia is always here to help too.
Contact your State/Territory Arthritis Office (on the details outlined below) to find out about their wide range of resources, management programs and support groups – call 1800 011 041 or visit www.arthritisaustralia.com.au.
In addition, there are Independent Living Centres in each state that provide advice on products and services, including aids and devices, that can help with day-to-day activities. Visit www.ilcaustralia.org.au or call 1300 885 886 for your closest centre or more information.
Who can help?
There are many people who can help you deal with both the functional and emotional side of rheumatoid arthritis. Your first step is to try to talk honestly with your partner, parents or children about how you feel. Give them a chance to talk too – they might have worries or feel that they don’t know enough about your disease and how it is affecting you.
Visit your GP if you are worried about how well you are coping, as your GP may be able to suggest additional ways of coping, or may prescribe medicines if you are especially worried or depressed. Many people with rheumatoid arthritis will also visit a physiotherapist (physio). These practitioners can use various treatments, including exercise therapy and hydrotherapy (water exercise), to keep your joints as flexible, strong and pain-free as possible. They will also show you exercises and pain-relief techniques to use at home.
You might also visit an occupational therapist (OT), or they may come to your home or work. OTs can provide advice on how to do things in a way that reduces joint strain and pain and teach you strategies to protect the mobility of your joints, particularly those in your hands. They may also suggest changes to your house — such as new taps — or aids such as splints that can make life easier and protect your joints.
A podiatrist can help take care of your feet. They may find ways to reduce the pain in your toes, knees or hips, perhaps by providing shoe inserts or advice on footwear.
An exercise physiologist can give you advice about exercise, including how to get started safely and the best type of exercise for your health and ability.
Your GP may also refer you to a counsellor or psychologist, who can talk to you about your worries, feelings and moods, then suggest practical ways to work through them. If you want to contact a psychologist directly, call the Australian Psychological Society on 1800 333 497 or visit www.psychology.org.au. Beyondblue also provides information and advice about depression, anxiety, available treatments and where to get help. Visit www.beyondblue.org.au or call 1300 22 4636. Lifeline provides a 24hr confidential telephone crisis support service for anyone across Australia experiencing a personal crisis. Call 13 11 14.
Arthritis Infoline: 1800 011 041
Please call our toll free national Arthritis Infoline number for information about arthritis and other musculoskeletal conditions including self-management, community programs, seminars, support groups, resources etc. The infoline is staffed by health professionals and specially trained volunteers who are able to answer most questions about living with arthritis. Alternatively, contact Arthritis Australia, or your local state or territory using the details below.
Arthritis Australia
Phone: (02) 9518 4441
Fax: (02) 9518 4011
Email: [email protected]
Website: www.arthritisaustralia.com.au
Freecall: 1800 111 101
State and Territory Support
Australian Capital Territory
Phone: (02) 6251 2055
Fax: (02) 6251 2066
Email: [email protected]
Web site: www.arthritisact.org.au
Infoline: 1800 011 041
New South Wales
Phone: (02) 9857 3300
Fax: (02) 9857 3399
Email: [email protected]
Web site: www.arthritisnsw.org.au
Infoline: 1800 011 041
Northern Territory
Phone: (08) 8948 5232
Fax: (08) 8948 5234
Email: [email protected]
Web site: www.aont.org.au
Infoline: 1800 011 041
Queensland
Phone: (07) 3857 4200
Fax: (07) 3857 4099
Email: [email protected]
Web site: www.arthritis.org.au
Infoline: 1800 011 041
South Australia
Phone: (08) 8379 5711
Fax: (08) 8379 5707
Email: [email protected]
Web site: www.arthritissa.org.au
Infoline: 1800 011 041
Tasmania
Phone: (03) 6228 4824
Email: [email protected]
Website: www.arthritistas.org.au
Infoline: 1800 011 041
Victoria
Infoline: 1800 011 041
Western Australia
Phone: (08) 9388 2199
Fax: (08) 9388 4488
Email: [email protected]
Website: www.arthritiswa.org.au
Infoline: 1800 011 041
Further information
Additional resources in Australia:
For access to quality online information about rheumatoid arthritis, start at Health Direct www.healthdirect.gov.au
For advice on healthy eating and appropriate exercise, visit Healthy Active www.healthyactive.gov.au
For advice on quitting smoking, contact the Quitline www.quitnow.gov.au
Ph: 13 78 48
To find a rheumatologist, contact the Australian Rheumatology Association www.rheumatology.org.au
Ph: (02) 9252 2356
To find a dermatologist, contact the Australasian College of Dermatologists www.dermcoll.edu.au
Ph: (02) 8741 4101
To find a physiotherapist, contact the Australian Physiotherapy Association www.physiotherapy.asn.au
Ph: 1300 306 622
To find an occupational therapist, contact Occupational Therapy Australia www.otaus.com.au
Ph: 1300 682 878
To find a podiatrist, contact the Australasian Podiatry Council www.apodc.com.au
Ph: (03) 9416 3111
To find an exercise physiologist, contact Exercise and Sports Science Australia www.essa.org.au
Ph: (07) 3171 3335
To find a dietitian, contact the Dietitians Association of Australia www.daa.asn.au
Ph: 1800 812 942
To find a psychologist, contact the Australian Psychological Society www.psychology.org.au
Ph: 1800 333 497
International resources
The public area on the website of the American College of Rheumatology contains many useful resources www.rheumatology.org
Arthritis Research UK also provides a wide variety of information for people with arthritis www.arthritisresearchuk.org
Arthritis Research UK – Sex, pregnancy and rheumatoid arthritis
Arthritis Research UK – Exercises to manage pain
http://www.arthritisresearchuk.org/arthritis-information/exercises-to-manage-pain.aspx
Arthritis Research UK – Daily life tips
http://www.arthritisresearchuk.org/arthritis-information/arthritis-and-daily-life.aspx
Thank you to Arthritis Society (Canada) and Arthritis Research UK for contribution of content and materials the above overview.
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